| NPI | 1003378274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D6660-C1) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 0000000000000) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2021-01-17 |